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Review
. 2023 Jan 15;15(1):452-465.
eCollection 2023.

Can proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors regress coronary atherosclerotic plaque? A systematic review and meta-analysis

Zijia Wu  1 , Lulan Gao  2 , Zhihai Lin  1
Affiliations
Review

Can proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors regress coronary atherosclerotic plaque? A systematic review and meta-analysis

Zijia Wu et al. Am J Transl Res. .

Abstract

Objective: Whether inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) promotes the regression of coronary atherosclerotic plaque in statin-treated individuals remains unclear. This study examined whether PCSK9 inhibitors combined with statin therapy could increase atherosclerotic plaque regression compared with statin therapy alone.

Methods: PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the database Clinical trials, and the Web of Science were searched to report the coronary atherosclerotic plaque of PCSK9 inhibitors using intravascular ultrasonography (IVUS) or optical coherence tomography (OCT) in statin patients. The weighted mean difference (WMD) of the random-effects/fixed-effects model was used to pool data that satisfied our inclusion criteria obtained from the included studies.

Results: When compared with statin therapy alone, pooled studies revealed that PCSK9 inhibitors combined with statin therapy significantly decreased percent atheroma volume (PAV) (WMD: -1.06%, 95% confidence interval [CI]: -1.39 to -0.73; P<0.001) and total atheroma volume (TAV) (WMD: -6.38 mm3, 95% CI: -10.12 to -2.64; P=0.001). Moreover, the fibrous cap thickness (FCT) of the coronary atherosclerotic plaque increases to 21.31 um (WMD: 21.31, 95% CI: 7.08 to 35.53, P<0.001), and the maximum lipid arc decreases 10.9° (WMD: -10.9, 95% CI: -15.24 to -5.34, P<0.001).

Conclusion: In our systematic review and meta-analysis, PCSK9 inhibitors combined with statin therapy were found to be more effective than statin therapy alone for slowing coronary plaque progression by decreasing PAV, TAV, and increasing FCT, maximum lipid arc.

Keywords: Coronary atherosclerotic plaque; IVUS; OCT; PCSK9 inhibitors.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
The forest plots (A-D) illustrate the effect of combination therapy (PCSK9 inhibitor plus statin) versus statin therapy on the changes in lipid volume and fibrous cap between baseline and follow-up. (A: Percent atheroma volume (PAV); B: Total atheroma volume (TAV); C: Fibrous cap thickness (FCT); D: Lipid arc).
Figure 3
Figure 3
A, B. Illustrate the comparison of fibrous cap thickness (FCT) and total atheroma volume (TAV) between the combination therapy (PCSK9 inhibitor + statin) and the statin therapy (sensitivity analysis).
See this image and copyright information in PMC

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